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Marcel Proust and the Global History of Asthma

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Marcel Proust and the Global History of Asthma Marcel Proust and the global history of asthma Professor Mark Jackson Centre for Medical History University of Exeter England Marcel Proust, 1871-1922 z born in Paris z Les Plaisirs et les Jours (1896) z À la recherche du temps perdu (1913-27) z Literary preoccupations with memory and guilt z Died from pneumonia Marcel Proust’s asthma z first attack, aged 9, walking in the Bois de Boulogne z regular, severe attacks of asthma and hay fever throughout his life, shaping his daily rhythms and dictating his creativity – slept during the day and worked at night z described in detail, particularly in letters to his mother Marcel Proust’s asthma `Ma chère petite Maman, An attack of asthma of unbelievable violence and tenacity – such is the depressing balance sheet of my night, which it obliged me to spend on my feet in spite of the early hour at which I got up yesterday.’ (c. 1900) `As soon as I reached Versailles I was seized with a horrifying attack of asthma, so that I didn’t know what to do or where to hide myself. From that moment to this the attack has continued.’ (26-8-1901) Marcel Proust’s asthma `Cher ami, I have been gasping for breath so continuously (incessant attacks of asthma for several days) that it is not very easy for me to write.’ (Letter to Marcel Boulenger, January 1920) Treating Proust’s asthma z Stramonium cigarettes `Ma chère petite maman, z Legras powders Yesterday after I wrote to you I z Espic powders had an asthma attack and incessant running at the nose, z Epinephrine which obliged me to walk all z Caffeine doubled up and light anti-asthma z Carbolic acid fumigations cigarettes at every tobacconist’s z Escouflaire powder as I passed, etc. And what’s fumigations worse, I haven’t been able to go z Isolation – cork-lined bedroom to bed until midnight, after endless fumigations . .’ z Opium z Morphine (31 August 1901) z Sea, lakeside and mountain resorts Aristocratic diseases Asthma and hay fever regarded as `nervous’ conditions, more prevalent in the educated, civilised upper classes: `The fact of exemption from hay fever of savages and practically of the laboring classes in civilized countries, suggest that we must look upon hay fever as one of the consequences of higher civilisation.’ William Dunbar, 1903 Aristocratic diseases `Sufferers from hay fever may, however, gather some crumbs of comfort from the fact that the disease is almost exclusively confined to persons of cultivation. As, therefore, summer sneezing goes hand-in-hand with culture, we may, perhaps, infer that the higher we rise in the intellectual scale, the more is the tendency developed. Hence, as already hinted, our national proclivity to hay fever may be taken as proof of our superiority to other races.’ Morell Mackenzie, 1884 Asthma and social class: late 20th century Asthma and social class: late 20th century Asthma, ethnicity and social class: late 20th century Explaining the shifting image of asthma 1. Rising trends in asthma 2. Rising mortality from asthma 3. Race and asthma 4. Global trends in asthma 1. Rising trends in asthma z Warren Vaughan, 1941 z 3.5 million asthma sufferers in US z 6 million hay fever sufferers z 12 million patients needing treatment for allergies 1. Rising trends in asthma 1. Rising trends in asthma 2. Rising mortality from asthma z Prior to the mid-20th century, asthma was regarded as a mild condition which was rarely fatal unless complicated by other diseases: `Spasmodic asthma not only does not directly destroy, but is compatible with remarkable prolongation of, life: the popular adage likens the possession of the disease to a “lease of long life”.’ Walter Hayle Walsh, 1871 2. Rising mortality from asthma 2. Rising mortality from asthma z 1959-66: asthma mortality increased x 8 in children 10-14 years z 1959-66: deaths from asthma increased from 1% to 7.2% all deaths in same age group z 1966: asthma the 4th commonest cause of death 2. Rising mortality from asthma 2. Rising mortality from asthma 3. Race and asthma 3. Race and asthma – The Times 1965 3. Race and asthma Possible explanations for asthma epidemics in US inner city areas: z emotional conflict z `damaged black psyche’ z urban air pollution z environmental inequalities, poor housing, cockroach infestation (1967) Waves of asthma declined in 1970s as the result of new housing, Medicaid, allergy and asthma outpatient clinics, and new asthma drugs. 4. Global trends in asthma z 1960s: WHO immunology unit - Howard Goodman, Giorgio Torrigiani - clinical immunology and immunopathology, including allergies z 1970s, Alain de Weck, Bern z WHO meetings: z 1978, Geneva z 1984, Florence 4. Global trends in asthma Results of WHO surveys: 1. The existing burden of asthma and other allergic diseases in developing countries was not insignificant. 2. The prevalence of asthma in developing countries was likely to increase with industrialisation and Westernisation. 4. Global trends in asthma 1. Papua New Guinea z 1960s: asthma rare z 1980s: 7.3% adult population 2. Japan z asthma prevalence doubled between 1955 and 1971 z hay fever: none in 1930s, but 33% children by 1986 3. India z Delhi study, 1961: 1.81% z Patna study, 1966: 1.76% z 1992-5: 3.5-6% z Late 1990s: 15% Conclusion.
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